The Miller Lab

The Miller lab forms part of the Neonatal Neuroscience Research group at SickKids. As part of the Centre for Brain and Mental Health, our shared vision is that “Every Child Deserves a Healthy Start, Strong Mind and Bright Future”. We focus on understanding how to provide brain-protective intensive care of the newborn.The brain undergoes an incredible period of development during the third trimester of pregnancy and in the first months of life. These changes make the brain vulnerable to injury but also endow it with an incredible capacity for recovery. Brain injury in the newborn is an important cause of impairments in motor skills, cognitive (thinking, reasoning, learning) development and language abilities. A better understanding of the causes of brain injury in the newborn will ultimately lead to prevention and new treatments to promote recovery and healthy development for all newborns.

Our team is using advanced magnetic resonance (MR) techniques and bedside brain monitoring to understand the causes of brain injury and impaired neurodevelopment in high-risk newborns. Our multidisciplinary research team includes experts in brain imaging, brain monitoring, clinicians, statisticians and nursing staff. We also collaborate with the Neonatal Neuroscience group at the Child & Family Research Institute in Vancouver. As a team, we work to improve neurodevelopmental outcomes in the following vulnerable populations:

Premature newbornsChildren born before term age (preterm) are at a very high disk for developmental delays including cognitive, motor, and language impairments. This population of newborns is at an especially high risk of injury to the white matter in the brain. We have discovered that the brain does not mature normally in many preterm babies as they grow to their due date (full term). This abnormal brain maturation is related to the many illnesses they may develop after birth, including infections and poor growth. In our studies, we focus on understanding why white matter injury and abnormal brain development occur, what these changes mean for a baby’s longer-term development, and what can be done to prevent these brain conditions.

Newborns with Congenital Heart DiseaseNewborns with heart defects (congenital heart disease) share a similar risk of brain injury, abnormal brain development and developmental delays with babies born preterm. Working with cardiologists and cardiac surgeons, and using advanced MRI before and after birth, we aim to determine the reasons why newborns with heart defects acquire brain injury and have abnormal brain development. Our ultimate goal is to develop strategies to optimize brain development and functional outcomes in this group of newborns.

Term Newborns with Hypoxic-Ischemic EncephalopathyDue to multiple factors, some newborns lack oxygen and blood flow at birth and sustain brain injury. They are said to have altered consciousness (encephalopathy) due to a lack of oxygen delivery to the brain (hypoxia-ischemia). These newborns usually require intensive care. Bringing their body temperature down for a short period of time is a method now used in the treatment of these babies (therapeutic hypothermia). Seizures are also frequent in these babies and can contribute further to their brain injury. Long-term outcome prediction is of utmost importance in this population. We are working closely with different experts in the fields of neonatology, electrophysiology and neuroimaging to improve the care of these children and to refine our ability to predict outcomes.

Upcoming workIn collaboration with the Kobor Lab at UBC and CFRI, we are exploring the role of infection in the preterm newborn on the epigenome. We will be studying preterm newborns with post-natal infection to determine if the epigenome is influenced by their postnatal experience, and whether changes in the epigenome influence their longer-term development of motor, cognitive, and language skills.

The ultimate goal of our team’s work is to promote strategies to prevent brain injury, and to promote recovery if the brain is injured. We predict that many of the therapies used routinely in neonatal and pediatric intensive care units have the potential to optimize brain development, lower rates of neonatal brain injury, and improve the lifelong health of children and their families.